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According to the Community Guide (usa.gov, 2009), evidence-based interventions shown to increase breast cancer screenings include:
- Client reminder systems – 16 studies confirm that client reminder systems increase breast cancer screening. Interventions may include use of letters, postcards or phone calls to alert clients that it is time for their cancer screening.
- Small media – 17 studies confirm that small media efforts (such as videos, printed materials, letters, brochures and newsletters) increase breast cancer screening. Tailored interventions may include videos and printed materials geared towards specific individuals, specific populations or general audiences.
- One-on-one education – 25 studies confirm that one-on-one education increases breast cancer screening. Health care providers can deliver one-on-one education in clinical settings, at home, by phone or in local gathering places. Some studies indicate that physicians may be less likely to recommend mammography to low-income, less educated women (O’Malley et al., 2001).
- Reducing structural barriers – Seven studies confirm that reducing structural barriers increases breast cancer screening. Barriers include distance from screening location, limited hours of operation, lack of day care for children, and language and cultural factors. Other barriers identified in Colorado include fear of diagnosis/treatment, immigrant status and lack of understanding medical terminology (Komen Community Profile Report, 2009).
- Reducing out-of pocket costs – Eight studies confirm that reducing out-of-pocket costs increases breast cancer screening. Interventions may include providing free or low-cost services, reimbursing clients or clinics, and/or reducing health insurance premiums or co-payments.
Information about why these strategies are important can be found in the section.
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online pharmacyFew studies have evaluated interventions that may improve women’s compliance with follow-up on abnormal breast cancer screenings, but amongst those studies some strategies are outlined including:
- Reducing anxiety after an abnormal result – nearly 50% of women who have abnormal mammograms report symptoms of anxiety three weeks after completing follow-up. Interventions to reduce this anxiety include immediate feedback from the mammography facility and avoiding periodic follow-up 3-6 months after the initial screening. Educational interventions did not decrease women’s anxiety after an abnormal result (Barton, Morley, Moore, Allen, Kleinman, Emmons & Fletcher, 2004).
- Case management/patient navigation – Women who receive evidenced-based case management services are 6.4 times more likely to be to be adherent with completing follow-up care (Vourlekis, Ell & Padgett, 2005) and are more likely to complete follow-up care in a timely fashion (Wells et al, 2008; Psooy, Schreuer, Borgaonkar & Caines, 2004). Interventions may include making telephone reminders, providing systems navigation, performing assessments of individual-level barriers and mental health assessments. Individual-level barriers may include lack of understanding what follow-up procedures are required, fear of cancer, cultural beliefs, emotional state, competing priorities, lack of social support and lack of usual source of health care (Vourlekis, et al., 2005).
Several studies have found that patient navigation services provide better outcomes for breast cancer patients; however, studies are limited and provide little information regarding their efficiency or cost-effectiveness (Wells et al, 2008). One study reported that the length of time from diagnosis to treatment was shorter for women receiving patient navigation services (Schwaderer et al., 2008). Women may also experience fewer treatment interruptions when receiving patient navigation services (Peteriet et al., 2008). According to Wells et al. (2008), patient navigators may assist with:
- Overcoming health system barriers such as coordinating care with multiple providers and facilitating patient provider communication
- Providing health education on topics like genetic testing, treatment options and treatment side-effects
- Overcoming patient barriers by addressing issues such as lack of transportation, financial and insurance barriers, lack of child care or language translation, and low health literacy.
- Providing psychosocial support that may be done either directly or by referring patients to social workers or cancer support groups
Information about why these strategies are important can be found in the section.
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Establishing a more comprehensive cancer survivorship plan is one way to prevent the disconnect between initial cancer treatment, long-term survivorship issues and reducing breast cancer mortality. Treatment of breast cancer is a complex process that requires consultation with multiple medical specialists in multiple settings. The use of cancer survivorship care plans cannot be considered an evidence-based practice that improves health outcomes yet, more research is needed to demonstrate the effectiveness of this strategy (Gilbert et al., 2007). However, the Iinstitue of Medicine (2005) and the National Institutes of Health (2008) recommend that certain key components be addressed in cancer survivorship care plans:
- Summary of all cancer treatments received with short and long-term side effects and toxicities, and contact information from treating institutions and providers
- Detailed cancer specific information such as tumor sites, stage, grade, hormonal status, and marker information
- Likely course of recovery
- Recommended preventative treatments
- Language about what each health care provider is responsible for
- Evidenced – based standards of care for future cancer screenings
- Psychosocial, nutritional, and other supportive services required
- Identification of key point of contact and coordinator for continuing care
Information about why these strategies are important can be found in the section.
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